ID patho Flashcards
(49 cards)
what constitutes a fever?
temp >37.8
what is the pathophysiology of fever?
1.infectious agent or toxin is present
2. monocytes/macrophages release pyrogenic cytockines (IL-1&6, TNF, IFNs)
3. cytokines stimulate hypothalamus which results in elevated thermoregulatory set point
4. increased heat conservation & production result in fever
what are signs and symptoms of fever
diaphoresis, shivering, headache, myalgia, weakness, anorexia
serious: confusion, hallucinations, dehydration
what instances of fever must be referred?
newborns/children <3months, fever of unknown origin (FUO)
what is a fever of unknown origin
temp of >38.3 that remains undiagnosed after 3 days of hospital investigation or 2+ outpatient visitis
what are potential causes of FUOs
infection, malignancy, autoimmune disorders, non-infectious causes (drugs, hepatitis, PE, MI, CVA)
what lab work would be ordered to diagnose FUO
CBC, lytes, creatinine, LFTs, blood cultures, urinalysis & urine C&S, chest x-ray, lumbar puncture, stool culture
what is the treatment for FUO
IV fluids, antipyretics, antiemetics, analgesics –> reasses and manage as appropriate
what is SIRSs
systemic inflammatory response syndrome
what is SIRS criteria
2 or more of the following general variables:
1. temp >38.3 or <36
2.HR >90
3. tachypnea
OR
inflammatory variable:
1.WBC >12000 (leukoctosis) or <4000 (leukopenia)
2. >10% immature leukocytes (left shift)
what is sepsis
2 or more SIRS criteria
what is severe sepsis
sepsis complicated with one or more organ system dysfunctions (decreased LOC, acute respiratory failure (ARF), Acute respirotory distress (ARDS), hepatic dysfunction)
what is septic shock
severe sepsis complicated by persistant hypotension refractory to early fluid therapy (SBP<90)
what is the pathophysiology of sepsis and septic shock
infectious or non-infectious agent stimulates release of pro-inflammatory cytokines that activate the coagulation cascade ==> leads to
1. throbosis and multiorgan failure
2. vasodilation & hypovolemia leads to low vascular resistance (SVR)
3. hypoxia due to persistant low arterial pressure leads to tachypnea
4.systemic inflammation from renal dysfunction, GI disturbance, & clotting abnormalities
what is the management of septic shock
intubation, fluid resuscitation (NS bolus), broad-spectrum abx, id source, vasopressors (NE, Dopamine, Epi, Vasopressin), inotropic agents, blood products, manage glucose, dialysis, prevent DVT, prevent ulcers, address nutrition
how do you diagnose influenza
clinical symptoms (fever, chills, cough, sore throat, HA, photophobia, N/V, loss of appetite, weakness)
may use swab if it will influence treatment -more often in high risk populations
what is treatment for the flu
-healthy individuals: rest & fluids
-severe or comorbidities: osetamivir (Tamiflu) or Zanamivir (Relenza)
-All: antpyretics (NSAIDs, acetaminophen)
what are considerations with osetamivir
adjust in renal impairment
what are considerations with zanamivir
don’t use in patients with asthma or COPD
what are common bacteria that cause community acquired pneumonia
S/M/C pneumoniae, H influenzae
what are clinical manifestations of pneumonia
productive cough (sudden onset), pleuritic chest pain, fever, chills, rigors, dyspea, tachypnea, tachycardia, headache, myalgias (muscle soreness), abn auscultation (rales, dullness on percussion)
what are symptoms you look at to decide on management of pneumonia
CRB-65: 1 point for each
confusion, rest >30, BP<90/60, 65+
0-1: treat at home
2+: sent to ER
what are important hx findings that may impact treatment decisions for pneumonia (1st/2nd line abx, duration of therapy)
-recent abx or hospitalization (3months)
-heart disease
-kidney disease
-liver disease
-lung disease
-DM
-alcoholism
-malignancies
-immunosuppression
what instances with pediatric pneumonia require ER referral
under 3 months OR any age with:
-toxic appearance, resp distress, dehydration, vomitting, no response to abx within 24hrs
